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Chapter 1
Introduction
1.1 Introduction
1.2 Unplanned pregnancy
1.3 Provision of contraceptive services
1.4 UK Medical Eligibility Criteria for contraception
References
1.1 Introduction
This short book provides up-to-date information, often in note form, about the commonly used contraceptive methods available in high resource countries and is aimed at healthcare professionals working in primary, community and secondary services. The book’s content is based on guidance from the Faculty of Sexual and Reproductive Healthcare’s Clinical Effectiveness Unit and the National Institute for Health and Care Excellence. References will appear at the end of each chapter when specific studies or reviews are mentioned.
Chapter 2, covering the consultation, explores the necessary points to discuss when seeing couples about contraception, including their ideas, concerns and expectations. Chapter 3 looks in more detail at the provision of contraception to special groups such as young people and those with learning difficulties. Each method will then be examined in turn, with information identifying potential users of the method, how it works, its efficacy, the advantages and disadvantages, how to start and stop the methods (where appropriate) plus the management of troublesome side-effects. The book concludes with two chapters on screening women for asymptomatic sexually transmitted infections (STI) and managing unplanned pregnancies.
1.2 Unplanned pregnancy
Keeping up to date in this field is difficult, especially when contraception is not your special interest. Yet men and women will seek advice from approachable healthcare staff who are non-judgemental and can give non-directional support. Hopefully being better prepared will help couples plan their pregnancies. However, at the current time it is estimated that almost 50% of pregnancies worldwide are unplanned. One in three women from high resource countries experiences an abortion during their lifetime, with a third requiring a repeat procedure.
Over 80% of abortions take place in women aged 20 or over, not the teenagers that are so often vilified. Free provision of contraception has had little effect on the abortion rate in England and Wales (Figures 1.1–1.3), with at least 60% of women using a contraceptive method at the time of the abortion. However, the most commonly cited methods are oral contraceptives or condoms, which require correct and consistent use. This high number of unplanned pregnancies may reflect poor contraceptive knowledge in the population. There may be issues related to funding of contraceptive services in primary and community care which limit access to and availability of contraceptive choice. Time pressures during consultations reduce the ability to explore fears and concerns surrounding some methods. This can result in couples choosing a contraceptive that fails to fit their lifestyle, for example an inability to adhere to daily regimens, leading to high typical failure rates for pills, condoms and natural methods when compared with perfect use (Table 1.1).
Table 1.1 Summary table of contraceptive efficacy – percentage of women experiencing an unintended pregnancy during the first year of typical and perfect use of contraception, and the percentage continuing use of that contraceptive at the end of the first year of use
| Contraceptive method | Women experiencing an unintended pregnancy within the first year of use (%) | Women continuing use at 1 year (%) |
| Typical use | Perfect use |
| No method | 85 | 85 | |
| Spermicides | 28 | 18 | 42 |
| Fertility awareness-based methods | 24 | | 47 |
| Simplified calendar method | | 5 | |
| Two day method | | 4 | |
| Ovulation method | | 3 | |
| Symptothermal method | | 0.4 | |
| Withdrawal | 22 | 4 | 46 |
| Sponge | | | 36 |
| Parous women | 24 | 20 | |
| Nulliparous women | 12 | 9 | |
| Condom | | | |
| Female | 21 | 5 | 41 |
| Male | 18 | 2 | 43 |
| Diaphragm | 12 | 6 | 57 |
| Combined pill and progestogen-only pill | 9 | 0.3 | 67 |
| Evra patch | 9 | 0.3 | 67 |
| NuvaRing | 9 | 0.3 | 67 |
| Depo-Provera | 6 | 0.2 | 56 |
| IUDs | | | |
| ParaGard (copper T) | 0.8 | 0.6 | 78 |
| Mirena (LNG) | 0.2 | 0.2 | 80 |
| Implanon | 0.05 | 0.05 | 84 |
| Female sterilization | 0.5 | 0.5 | 100 |
| Male sterilization | 0.15 | 0.10 | 100 |
| Adapted from Trussell (2012) Contracep tive failure in the United States. Contraception, 83: 397. |
1.3 Provision of cont...
